Over the years, we all have had the privilege of working and collaborating with many physician anesthesiologists in the United States, Europe and various other countries. In Europe, anesthesiology is a physician-focused practice and nurses function in different supporting roles; in some countries, nurse anesthesia does not exist. The United States’ use of a variety of advanced practice providers, including nurse anesthetists and physicians assistants, is the exception rather than the rule in most European systems. This, from a management perspective and political perspective, is an important major difference in Europe compared to the U.S. Non-physician anesthesiology providers were developed earlier in our clinical history to provide coverage.

The physician-centric management concept also evolved differently in the U.S. and, as a result, European anesthesiologists have an important involvement in overall medical care that extends far beyond the O.R. delivery...

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